Undescended testis in children

An undescended testis (cryptorchidism) is a condition where one or both testicles fail to move down into the scrotum before birth or shortly afterwards. It’s one of the most common conditions seen in paediatric urology, affecting around 2 to four per cent of full-term male infants. Understanding how this condition is diagnosed and treated is important for parents, as early management helps protect fertility and reduce future health risks.

What is an undescended testis?

During development in the womb, a baby’s testicles normally move from the abdomen into the scrotum before birth. In some babies, one or both testicles do not complete this journey and remain in the groin or abdomen. In some cases, the testis may descend naturally within the first few months of life, but if it remains undescended by six months of age, it is unlikely to do so without treatment.

How is the condition diagnosed?

An undescended testis is usually detected during routine newborn checks or follow-up examinations by a GP or paediatrician. Diagnosis is typically made by:

Physical examination to feel whether the testis is present in the groin or scrotum
Ultrasound scanning if the testis cannot be felt during examination
Occasionally, further imaging or laparoscopy to locate testes that are higher in the abdomen

Early detection ensures timely treatment, preventing long-term complications.

Why is treatment important?

Leaving an undescended testis untreated can lead to:

Reduced fertility later in life if the testis remains at a higher temperature in the abdomen
Increased risk of testicular cancer compared to testes that descend normally
Greater chance of injury or twisting (torsion) if the testis is not fixed in place
Psychological impact as the child grows older if the scrotum appears underdeveloped

How is an undescended testis treated?

The main treatment for undescended testis is a surgical procedure called orchidopexy, usually performed between 6 and 12 months of age. This involves moving the testis into the scrotum and securing it in place. The surgery is straightforward, performed under general anaesthetic, and most children can go home the same day.

In rare cases, if the testis is absent or severely underdeveloped, a surgeon may discuss other options, including monitoring or future procedures to place a testicular implant for cosmetic reasons.

What is the outlook after treatment?

When treated early, the outlook for children with an undescended testis is excellent. Fertility potential is preserved, the risk of testicular cancer is reduced, and the scrotum develops normally. Long-term follow-up may be recommended to check the position and size of the testis as the child grows.

When should parents seek specialist advice?

If a testis is not visible or cannot be felt in the scrotum by six months of age, parents should seek referral to a paediatric urologist or surgeon. Prompt evaluation and treatment give the best chance of a healthy outcome.